Critically evaluate the role of non-invasive ventilation (NIV) in critically ill patients.
Rationale
NIV provides ventilatory support for patients with respiratory failure via a sealed face-mask, nasal mask, mouthpiece, full face visor or helmet without the need for intubation. Ventilatory support may be with CPAP or bi-level modes and delivered by a range of ventilators from specifically designed devices to full-service ICU ventilators.
NIV decreases resource utilisation compared with invasive ventilation and avoids the associated complications.
Patient selection and a well-designed clinical protocol are important to avoid delaying intubation in patients who are not suitable for and/or failing NIV.
Indications
Evidence for its use:
Evidence against its use:
Predictors of success
Contra-indications
Complications
Alternatives
Summary statement / My Practice
Such as:
Additional Examiners’ Comments:
NIV is a fundamental part of intensive care practice and the overall level of understanding was poor. Few candidates were able to demonstrate detailed knowledge of this core therapy.
Candidates were not expected to include as much detail to score good marks. Essential points included indications, some mention of evidence for and against, contra-indications and complications. Candidates were given credit if they included valid points not in the answer template.
There is no way anybody could write all that in ten minutes unless they had a prefabricated answer all loaded and ready to go in their head.
Rationale for NIV
Strong indications for NIV
Weak indications for NIV
Disadvantages when compared to invasive ventilation
Contraindications for NIV
Complications of NIV
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